Transplant Center

Kidney-Pancreas or Pancreas Only

The Operation

A kidney/pancreas or pancreas only transplant is performed through a midline incision in the center of the abdomen.  The pancreas is generally placed on the right side of the abdomen and the kidney, if performed at the same time, is placed on the left side of the abdomen.  The kidney and pancreas are attached to the necessary blood supply.  The kidney is attached to the bladder for urine drainage.  The pancreas is connected to the bladder or the bowel to drain the pancreas enzymes into the bladder or bowel. Generally, the native kidneys are left in place; however, exceptions to this may be made in the event of infection, the potential for infection or the presence of cancer. The native pancreas is left in place.

After the Operation

After the operation, you will be in either a private room in the Solid Organ Transplant Unit or in the Intensive Care Unit for recovery. The new kidney should start to work soon after the surgery, but it may be necessary to have dialysis in our inpatient dialysis facility until the kidney begins to work. The pancreas should also start to work soon after surgery, but it may be necessary to continue the use of insulin such as an insulin (intravenous) drip until blood sugars are in an acceptable range.

You should be able to walk and start eating a normal diet within a few days after the surgery. During this time, the staff closely monitors your progress with the appropriate tests to see how the new kidney and/or pancreas are working.

The transplant coordinator and doctors will instruct you on the following:

• How to take your medications
• Warning signs to look for
• How to read the blood tests and determine early signs of any problems
• When to call the Transplant Office

Immunosuppressive (Anti-rejection) Medications

Both before and after the transplant surgery, you will be given immunosuppressive (anti-rejection) medications. These are strong medications to help prevent rejection. These medications must be taken as long you have the transplanted organ(s). To determine a safe level of these drugs, your blood will be tested and the medication levels will be watched very closely by the transplant team.  It is very common for the transplant team to make frequent changes in medication doses after transplant.

Some problems can occur as a result of the side effects of the needed medications. The most common is the lowering of the ability to fight infection. The transplant surgeon and coordinator will discuss other potential problems, including signs and symptoms of rejection and infection.

Potential Complications

All treatments for kidney disease and diabetes have potential complications. Transplantation is no different. As a transplant patient, you need to be aware of the possibility of rejection and infection.

Rejection occurs when the body fights the donor's kidney and/or pancreas. This happens because the new kidney and/or pancreas are foreign tissue. Rejection is the most common reason for transplant failure. There are three types of rejection:

• Hyper-Acute Rejection- this type is very rare, but can occur minutes or hours after surgery and is not treatable. If it occurs, the kidney and/or pancreas must be removed and dialysis and/or insulin must be resumed until another kidney and/or pancreas is available.

• Acute Rejection- this can occur any time but is most common in the first year after transplant. This type of rejection is usually reversible with anti-rejection medications.

• Chronic Rejection- this occurs slowly and over a long period of time. There is usually no treatment. The kidney and/or pancreas function may decrease to the point that dialysis and/or insulin is required. If this occurs, you may decide to try another transplant. Some patients have two or more transplants.

The medications to protect you from rejection lower your immune system and put you at increased risk for infection.  The risk of infection is the greatest right after transplant or after treatment for rejection.  Some of the infection complications you may experience right after transplant may be a reactivation of viral infections that you may have had as child.  More specific information will be provided to you during the transplant evaluation and post-transplant education.

The Cost

Medicare and/or private insurance companies may cover the cost of a kidney and/or pancreas transplant. Some insurance companies may not cover the cost of medications needed after the transplant. A transplant financial counselor, transplant pharmacy counselor and a social worker will answer questions regarding insurance coverage, Medicare A, B and D, coordination of benefits, prescription coverage and other financial obligations.

Making the Choice

In most cases, a kidney and/or pancreas transplant offers you the best chance of returning to the highest quality of life possible. If you have questions, contact the Kidney/Pancreas Transplant Office at (402) 559-5000.